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Lyme disease: Knowledge and practices of family practitioners in southern Quebec.

Ferrouillet C, Milord F, Lambert L, Vibien A, Ravel A - Can J Infect Dis Med Microbiol (2015 May-Jun)

Bottom Line: Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices.The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal, St Hyacinthe; ; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal;

ABSTRACT

Background: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.

Objectives: To describe FPs' clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).

Methods: In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).

Results: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).

Conclusion: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.

No MeSH data available.


Related in: MedlinePlus

Map resulting from the multiple correspondence analysis of 151 general practitioners’ answers to six questions. The bubbles represent the relative location of each possible answer given for every question on the two-dimensional plan that shows most of the variability in the answers. The size of the bubbles is proportional to the number of respondents for the variable it represents. The questions were the following. 1) ‘When faced with a patient with a known tick bite but no symptoms and normal findings on examination, what do you do or what would you do?’ (dark gray bubble). The choices were ‘serology for Lyme disease’ (Bite: sero), ‘antibiotic treatment for Lyme disease’ (Bite: AB), ‘serology and antibiotic treatment for Lyme disease’ (Bite: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Bite: educ), ‘I need more information to manage this patient’ (Bite: info), ‘other action or treatment’ (Bite: other). 2) ‘When faced with a patient with erythema migrans (erythematous skin lesion typical of Lyme disease), what do you do or what would you do?’ (checked bubble). The choices were ‘serology for Lyme disease’ (Lesion: sero), ‘antibiotic treatment for Lyme disease’ (Lesion: AB), ‘serology and antibiotic treatment for Lyme disease’ (Lesion: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Lesion: educ), ‘I need more information to manage this patient’ (Lesion: info), ‘other action or treatment’ (Lesion: other). 3) ‘A patient brings you a tick that bit him/her. You send the tick to the laboratory for identification and to test for B burgdorferi. According to you, are the lab results useful for the diagnosis of Lyme disease?’ (horizontally striped bubble). Answer choices were ‘yes’ (Tick for Dx: yes), ‘no’ (Tick for Dx: no), and ‘don’t know’ (Tick for Dx: dk). 4) ‘What is the only characteristic that does not comply with the classical definition of erythema migrans?’ (light gray bubble). The choices were ‘bull’s-eye lesion’ (Not eryt: small), ‘expanding lesion larger than or equal to 5 cm’ (Not eryt: large), ‘lesion occurs in 60% to 80% of cases’ (Not eryt: freq), ‘painful lesion’ (Not eryt: pain), ‘don’t know’ (Not eryt: dk). 5) ‘In the case of fever, do you think the patient is in an acute phase of Lyme disease?’ (vertically striped bubble). The choices were ‘yes’ (Fever: yes), ‘no’ (Fever: no), or ‘don’t know’ (Fever: dk). 6) In a case of erythema migrans, do you think the patient is in an acute phase of Lyme disease?’ (white bubble). Choices were ‘yes’ (Eryt: yes), ‘no’ (Eryt: no), or ‘don’t know’ (Eryt: dk). Correct answers to the six questions are underlined on the map. Finally, the dark bubbles show the number of patients for whom the physician thought Lyme disease was a potential diagnosis during the year 2011 (LM-Dx: 0 patients, LM-Dx: 1–2 patients, LM-Dx: 3–5 patients and LM-Dx: 6–10 patients). See the figure highlights in the text.
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f3-idmm-26-151: Map resulting from the multiple correspondence analysis of 151 general practitioners’ answers to six questions. The bubbles represent the relative location of each possible answer given for every question on the two-dimensional plan that shows most of the variability in the answers. The size of the bubbles is proportional to the number of respondents for the variable it represents. The questions were the following. 1) ‘When faced with a patient with a known tick bite but no symptoms and normal findings on examination, what do you do or what would you do?’ (dark gray bubble). The choices were ‘serology for Lyme disease’ (Bite: sero), ‘antibiotic treatment for Lyme disease’ (Bite: AB), ‘serology and antibiotic treatment for Lyme disease’ (Bite: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Bite: educ), ‘I need more information to manage this patient’ (Bite: info), ‘other action or treatment’ (Bite: other). 2) ‘When faced with a patient with erythema migrans (erythematous skin lesion typical of Lyme disease), what do you do or what would you do?’ (checked bubble). The choices were ‘serology for Lyme disease’ (Lesion: sero), ‘antibiotic treatment for Lyme disease’ (Lesion: AB), ‘serology and antibiotic treatment for Lyme disease’ (Lesion: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Lesion: educ), ‘I need more information to manage this patient’ (Lesion: info), ‘other action or treatment’ (Lesion: other). 3) ‘A patient brings you a tick that bit him/her. You send the tick to the laboratory for identification and to test for B burgdorferi. According to you, are the lab results useful for the diagnosis of Lyme disease?’ (horizontally striped bubble). Answer choices were ‘yes’ (Tick for Dx: yes), ‘no’ (Tick for Dx: no), and ‘don’t know’ (Tick for Dx: dk). 4) ‘What is the only characteristic that does not comply with the classical definition of erythema migrans?’ (light gray bubble). The choices were ‘bull’s-eye lesion’ (Not eryt: small), ‘expanding lesion larger than or equal to 5 cm’ (Not eryt: large), ‘lesion occurs in 60% to 80% of cases’ (Not eryt: freq), ‘painful lesion’ (Not eryt: pain), ‘don’t know’ (Not eryt: dk). 5) ‘In the case of fever, do you think the patient is in an acute phase of Lyme disease?’ (vertically striped bubble). The choices were ‘yes’ (Fever: yes), ‘no’ (Fever: no), or ‘don’t know’ (Fever: dk). 6) In a case of erythema migrans, do you think the patient is in an acute phase of Lyme disease?’ (white bubble). Choices were ‘yes’ (Eryt: yes), ‘no’ (Eryt: no), or ‘don’t know’ (Eryt: dk). Correct answers to the six questions are underlined on the map. Finally, the dark bubbles show the number of patients for whom the physician thought Lyme disease was a potential diagnosis during the year 2011 (LM-Dx: 0 patients, LM-Dx: 1–2 patients, LM-Dx: 3–5 patients and LM-Dx: 6–10 patients). See the figure highlights in the text.

Mentions: The MCA map shows four most striking features (Figure 3). Correct answers are not highly clustered, which means that physicians providing correct answers to all questions were uncommon. The answers indicating lack of knowledge (‘don’t know’ and ‘need more information’ combined) are clustered on the right side of the map, indicating a tendency of a lack of knowledge for several questions for some physicians. The bubbles showing the numbers of patients with possible Lyme disease seen in 2011 are distributed from the right to the left of the map and in the opposite direction of the answers, indicating a lack of knowledge and suggesting a positive relationship between the numbers of potential Lyme disease cases seen by physicians and their knowledge (whether accurate or not) about the disease. Finally, incorrect answers or those indicating a lack of knowledge are spread all over the map, indicating an absence of pattern for incorrect answers to several questions. This shows a moderate lack of knowledge among physicians rather than systematic insufficient knowledge or practices and shows that this gap tends to decrease with clinical experience.


Lyme disease: Knowledge and practices of family practitioners in southern Quebec.

Ferrouillet C, Milord F, Lambert L, Vibien A, Ravel A - Can J Infect Dis Med Microbiol (2015 May-Jun)

Map resulting from the multiple correspondence analysis of 151 general practitioners’ answers to six questions. The bubbles represent the relative location of each possible answer given for every question on the two-dimensional plan that shows most of the variability in the answers. The size of the bubbles is proportional to the number of respondents for the variable it represents. The questions were the following. 1) ‘When faced with a patient with a known tick bite but no symptoms and normal findings on examination, what do you do or what would you do?’ (dark gray bubble). The choices were ‘serology for Lyme disease’ (Bite: sero), ‘antibiotic treatment for Lyme disease’ (Bite: AB), ‘serology and antibiotic treatment for Lyme disease’ (Bite: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Bite: educ), ‘I need more information to manage this patient’ (Bite: info), ‘other action or treatment’ (Bite: other). 2) ‘When faced with a patient with erythema migrans (erythematous skin lesion typical of Lyme disease), what do you do or what would you do?’ (checked bubble). The choices were ‘serology for Lyme disease’ (Lesion: sero), ‘antibiotic treatment for Lyme disease’ (Lesion: AB), ‘serology and antibiotic treatment for Lyme disease’ (Lesion: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Lesion: educ), ‘I need more information to manage this patient’ (Lesion: info), ‘other action or treatment’ (Lesion: other). 3) ‘A patient brings you a tick that bit him/her. You send the tick to the laboratory for identification and to test for B burgdorferi. According to you, are the lab results useful for the diagnosis of Lyme disease?’ (horizontally striped bubble). Answer choices were ‘yes’ (Tick for Dx: yes), ‘no’ (Tick for Dx: no), and ‘don’t know’ (Tick for Dx: dk). 4) ‘What is the only characteristic that does not comply with the classical definition of erythema migrans?’ (light gray bubble). The choices were ‘bull’s-eye lesion’ (Not eryt: small), ‘expanding lesion larger than or equal to 5 cm’ (Not eryt: large), ‘lesion occurs in 60% to 80% of cases’ (Not eryt: freq), ‘painful lesion’ (Not eryt: pain), ‘don’t know’ (Not eryt: dk). 5) ‘In the case of fever, do you think the patient is in an acute phase of Lyme disease?’ (vertically striped bubble). The choices were ‘yes’ (Fever: yes), ‘no’ (Fever: no), or ‘don’t know’ (Fever: dk). 6) In a case of erythema migrans, do you think the patient is in an acute phase of Lyme disease?’ (white bubble). Choices were ‘yes’ (Eryt: yes), ‘no’ (Eryt: no), or ‘don’t know’ (Eryt: dk). Correct answers to the six questions are underlined on the map. Finally, the dark bubbles show the number of patients for whom the physician thought Lyme disease was a potential diagnosis during the year 2011 (LM-Dx: 0 patients, LM-Dx: 1–2 patients, LM-Dx: 3–5 patients and LM-Dx: 6–10 patients). See the figure highlights in the text.
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Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4507841&req=5

f3-idmm-26-151: Map resulting from the multiple correspondence analysis of 151 general practitioners’ answers to six questions. The bubbles represent the relative location of each possible answer given for every question on the two-dimensional plan that shows most of the variability in the answers. The size of the bubbles is proportional to the number of respondents for the variable it represents. The questions were the following. 1) ‘When faced with a patient with a known tick bite but no symptoms and normal findings on examination, what do you do or what would you do?’ (dark gray bubble). The choices were ‘serology for Lyme disease’ (Bite: sero), ‘antibiotic treatment for Lyme disease’ (Bite: AB), ‘serology and antibiotic treatment for Lyme disease’ (Bite: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Bite: educ), ‘I need more information to manage this patient’ (Bite: info), ‘other action or treatment’ (Bite: other). 2) ‘When faced with a patient with erythema migrans (erythematous skin lesion typical of Lyme disease), what do you do or what would you do?’ (checked bubble). The choices were ‘serology for Lyme disease’ (Lesion: sero), ‘antibiotic treatment for Lyme disease’ (Lesion: AB), ‘serology and antibiotic treatment for Lyme disease’ (Lesion: sero+AB), ‘no serology, no antibiotics, educate patient, follow up as needed’ (Lesion: educ), ‘I need more information to manage this patient’ (Lesion: info), ‘other action or treatment’ (Lesion: other). 3) ‘A patient brings you a tick that bit him/her. You send the tick to the laboratory for identification and to test for B burgdorferi. According to you, are the lab results useful for the diagnosis of Lyme disease?’ (horizontally striped bubble). Answer choices were ‘yes’ (Tick for Dx: yes), ‘no’ (Tick for Dx: no), and ‘don’t know’ (Tick for Dx: dk). 4) ‘What is the only characteristic that does not comply with the classical definition of erythema migrans?’ (light gray bubble). The choices were ‘bull’s-eye lesion’ (Not eryt: small), ‘expanding lesion larger than or equal to 5 cm’ (Not eryt: large), ‘lesion occurs in 60% to 80% of cases’ (Not eryt: freq), ‘painful lesion’ (Not eryt: pain), ‘don’t know’ (Not eryt: dk). 5) ‘In the case of fever, do you think the patient is in an acute phase of Lyme disease?’ (vertically striped bubble). The choices were ‘yes’ (Fever: yes), ‘no’ (Fever: no), or ‘don’t know’ (Fever: dk). 6) In a case of erythema migrans, do you think the patient is in an acute phase of Lyme disease?’ (white bubble). Choices were ‘yes’ (Eryt: yes), ‘no’ (Eryt: no), or ‘don’t know’ (Eryt: dk). Correct answers to the six questions are underlined on the map. Finally, the dark bubbles show the number of patients for whom the physician thought Lyme disease was a potential diagnosis during the year 2011 (LM-Dx: 0 patients, LM-Dx: 1–2 patients, LM-Dx: 3–5 patients and LM-Dx: 6–10 patients). See the figure highlights in the text.
Mentions: The MCA map shows four most striking features (Figure 3). Correct answers are not highly clustered, which means that physicians providing correct answers to all questions were uncommon. The answers indicating lack of knowledge (‘don’t know’ and ‘need more information’ combined) are clustered on the right side of the map, indicating a tendency of a lack of knowledge for several questions for some physicians. The bubbles showing the numbers of patients with possible Lyme disease seen in 2011 are distributed from the right to the left of the map and in the opposite direction of the answers, indicating a lack of knowledge and suggesting a positive relationship between the numbers of potential Lyme disease cases seen by physicians and their knowledge (whether accurate or not) about the disease. Finally, incorrect answers or those indicating a lack of knowledge are spread all over the map, indicating an absence of pattern for incorrect answers to several questions. This shows a moderate lack of knowledge among physicians rather than systematic insufficient knowledge or practices and shows that this gap tends to decrease with clinical experience.

Bottom Line: Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices.The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Groupe de recherche en épidémiologie des zoonoses et santé publique, Faculté de médecine vétérinaire, Université de Montréal, St Hyacinthe; ; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal;

ABSTRACT

Background: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.

Objectives: To describe FPs' clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).

Methods: In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).

Results: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).

Conclusion: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.

No MeSH data available.


Related in: MedlinePlus